Individual
JOANNA BERGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
320 N NEW JERSEY ST, INDIANAPOLIS, IN 46204-2113
(463) 203-5178
(317) 423-2305
Mailing address
1015 BELVEDERE PL, WESTFIELD, IN 46074-8087
(463) 203-5178
(317) 423-2305
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26021458A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26021458A
STATE BOARD OF PHARMACY LICENSE
IN
Enumeration date
10/22/2018
Last updated
07/14/2019
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